*You must have Adobe Acrobat or a PDF Annotating Application to sign the Intake Packets. All forms must be signed before your appointment. You are welcome to print, complete the forms and scan to email before your appointment if you do not have either of the aforementioned applications.
We appreciate the opportunity to service you at this point in your life. Please complete the form below that relates to the type of appointment you are scheduling. Complete all areas of the paperwork and submit the form before your first session.* You may also email the completed paperwork to firstname.lastname@example.org.
If you are under the care of a psychiatrist or other mental health clinician, fill out the Authorization to Release Information form so that we may consult with them.
If you are scheduling an appointment for someone under the age of 18, be sure to fully complete the Child/Adolescent Questionnaire. For Couples, each partner should complete the Couple Questionnaire included in the packet.
Adolescents - $80
Adults (age 18+) - $100
Families - $120
Couples - $160
NO Insurance is being taken at this time.
Using Intangible Variables to Get Tangible Results